Birth Plans came into fashion many years ago, and every couple has their “take” on what should be included in that document. I often tell my students that Birth cannot be “planned” and often the harder we try and “make it” go a certain way, the further things sometime slip away. It’s always best to keep a flexible attitude when it comes to birth, holding a vision for what you might like, but being present for what’s happening and what’s needed in the moment. I’ve come to really like the concept of a Birth Preference sheet. This simple 1 or 2 pages can be a great springboard for discussion with your provider about things important to you, and be a great way to let your staff ( in a hospital birth) know how they may assist you. Take a look at one of my favorites (reprinted with permission). It’s concise, the table format is easy to read, and shows that these parents have done their research.
_____________________________________________________________________________
We are excited about the arrival of our baby and to be sharing this experience with the doctors and nurses of XX Hospital. Our ultimate goal is to ensure a healthy mother and healthy baby and we know we can achieve this with your help and guidance.
XXX, the birthing mother, will be joined during all stages by her partner XXX. We also will be utilizing the doula services of XXXXX.
This is the portion of our birth plan which outlines our wishes for Labor and Delivery. At your earliest convenience, please read through our plan and bring any items of question or concern to our attention. Mom can be reached at XXX-XXX-XXXX.
Best Regards, Mom & Partner
Labor
Labor
Preferences
Notes
Natural/Unmedicated Unless mom or baby is at risk, we are looking forward to an unmedicated, natural childbirth. Heprin Lock It is important for Mom to be able to move freely during labor. We would prefer a heprin lock rather than IV. Fetal Monitoring Unless baby is in distress, please monitor intermittently to allow mom to move around. Quiet Environment We would like a quiet environment to facilitate relaxation during labor. Light Snacks/Liquids Mom would like to snack lightly and drink fluids to maintain energy and hydration during labor.
Delivery
Delivery
Preferences
Notes
Varied Pushing Positions Please allow Mom to try different pushing positions if desired. Ease the Baby Out Please help Mom avoid tearing as much as possible by guiding her in easing the baby out. Avoid Cesarean We would like to avoid a cesarean unless Mom or Baby is at risk. Immediately After Birth
After Birth
Preferences
Notes
Delayed Cord Cutting We would like to cord to stop pulsating before being clamped and cut. Breastfeeding Immediately We would like to try breastfeeding immediately after delivery to encourage placental delivery. Spontaneous Placental Delivery We feel strongly about trying to deliver the placenta spontaneously. Please delay administering Pitocin until at least after breastfeeding and cord cutting. Newborn Care After Bonding Please delay routine newborn care until Mom has breast fed Baby and the happy family has had an opportunity to bond.
FOR NURSERY:
Thank you so much for taking care of our little boy for us while we are at the hospital.
This is the portion of our birth plan which outlines our wishes for Newborn and Postpartum Care. Please review at your earliest convenience and bring any items of question or concern to our attention. Mom can be reached at XXX-XXX-XXXX.
Best Regards, Mom & Partner
Newborn Care
Newborn Care
Item
Notes
Bottle/Pacifier Please do not offer without our consent. Postpartum Rooming-In We plan to room-in as much as possible. Nursery Care If baby is moved to the nursery, please return him to mom for feeding at any time of day or night.
Newborn Procedures
Newborn Procedures
We have reviewed the list of newborn procedures and would like to proceed as outlined below. If something is not on this list, please obtain our consent before proceeding.
Please Proceed
Notes
Bath We ask that baby only be rinsed with water – not scrubbed or cleaned with soap. It is okay with us if some vernix is left on his skin to come off in its own time. Temperature Regulation Eye Ointment PKU Glactecosemia Hearing test Vitamin K shot Pediatrician visit OPT OUT- Hepatitis B Shot no Consent given
Our Pediatrician
Practice Name
Address
Suite
City, State, Zip
Child’s Name – XXXXX
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